Auditor - Compliance - MPG: CORP - Compliance & Int Audit
Job Posting for Auditor - Compliance - MPG: CORP - Compliance & Int Audit at Memorial Healthcare System
Summary:
Responsible for auditing physician evaluation and management and procedures coding and billing to ensure they meet the official coding guidelines, medical necessity and compliance with regulatory requirements.
Responsible for auditing physician evaluation and management and procedures coding and billing to ensure they meet the official coding guidelines, medical necessity and compliance with regulatory requirements.
Detailed responsibilities:
- Review Memorial Physician Group (MPG) physician coding and billing for evaluation and management office visits and procedures.
- Audits medical records to verify documentation supports medical necessity and the accuracy of ICD-10 coding and evaluate the completeness of documentation to support procedure code assignment and services billed.
- Prepare formal audit report of audit background, steps and findings to presentation to executive leadership and the Board of Commissioners.
- Research all MPG Physicians on the Center for Medicare and Medicaid (CMS) national disclosure program database for financial relationships between drug and medical device companies and verify that the physician disclosed this information on their annual Conflicts of Interest questionnaires.
- Ensures compliance with regulatory agencies governing healthcare delivery, third party payers, and accrediting bodies.
- Follow up on audit findings to ensure that the corrective action plans are effective.
- Participates in investigations and responds to questions, issues, reports and formal inquiries by federal and state agencies of possible violations or non- compliance matters raised by employees, patients, physicians and the public.
- Monitor and assess compliance with state and federal laws and the System's policies and procedures to identify deviations and recommend corrective action.
- Communicates with and educates employees on the Memorial Healthcare System (MHS) Compliance Program.
Competencies and skills:
Essential:
- STANDARDS OF BEHAVIOR: Acts in a manner that supports the standards of communication, respect, privacy, and teamwork by demonstrating a commitment to professional and ethical conduct.
- CUSTOMER SERVICE: Demonstrates commitment to service excellence by promptly addressing internal/external customer issues/requests, resolving concerns while maintaining a professional image and behavior to build and enhance the patient/family/customer experience.
- ACCOUNTABILITY: Accepts ownership of job roles and specific assignments/goals; works independently, takes responsibility for own actions; admits mistakes and judgment errors; and accepts constructive feedback. Connects personal work results to the accomplishment of team and organizational goals.
- RESPONDING TO CHANGE: Accepts change and adapts in a positive and productive manner; handles unexpected situations and changes in direction calmly and with confidence. Views new assignments and job responsibilities as an opportunity for growth.
- ANALYSIS AND DECISION MAKING: Uses decision making processes and tools to analyze situations and make effective decisions.
- EFFECTIVE COMMUNICATION: Communicates effectively with various audiences using the most appropriate method for the situation.
- PROBLEM SOLVING: Ability to identify, analyze and effectively solve problems.
- HEALTHCARE INDUSTRY: Versed in healthcare industry's trends, directions, major issues, regulatory considerations and trendsetters.
Education:
Essential:
Essential:
- Associates
Education specialization:
Essential:
Essential:
- Health Information Management
Credentials:
Essential:
Essential:
- Other
Education equivalent experience:
Essential:
- or in Health Information Technology, Health Informatics or related field.
Other information:
Complexity of Work: This role requires critical thinking skills, effective communication, decisive judgment, and the ability to build and foster positive relationships. The incumbent must be able to lead.
Required Work Experience: Three (3) years of experience in coding in a physician practice setting or auditing physician practice coding and billing.
••Certified Coding Associate or Medical Coding Certificate required. Bachelor s Degree preferred. Certificated as Professional Medical Auditor preferred
Complexity of Work: This role requires critical thinking skills, effective communication, decisive judgment, and the ability to build and foster positive relationships. The incumbent must be able to lead.
Required Work Experience: Three (3) years of experience in coding in a physician practice setting or auditing physician practice coding and billing.
••Certified Coding Associate or Medical Coding Certificate required. Bachelor s Degree preferred. Certificated as Professional Medical Auditor preferred
Working conditions:
Essential:
Essential:
- Bending and Stooping 40.00%
- Climbing 40.00%
- Keyboard Entry 80.00%
- Kneeling 40.00%
- Lifting or Carrying 0 - 25 lbs Non-Patient 60.00%
- Lifting or Carrying 25.01 lbs - 75 lbs Non-Patient 40.00%
- Pushing or Pulling 0 - 25 lbs Non-Patient 60.00%
- Pushing or Pulling 26 - 75 lbs Non-Patient 40.00%
- Reaching 60.00%
- Repetitive Movement Hand/Arm 80.00%
- Sitting 80.00%
- Squatting 40.00%
- Standing 80.00%
- Walking 80.00%
- Audible Speech 80.00%
- Hearing Acuity 80.00%
- Depth Perception 60.00%
- Seeing - Far 80.00%
- Seeing - Near 80.00%
- Bio hazardous Waste 40.00%
- Biological Hazards - Respiratory 40.00%
- Biological Hazards - Skin or Ingestion 40.00%
- Blood and/or Bodily Fluids 40.00%
- Communicable Diseases and/or Pathogens 40.00%
- Dust 60.00%
- Gas/Vapors/Fumes 40.00%
- Hazardous Chemicals 40.00%
- Latex 60.00%
- Computer Monitor 80.00%
- Extreme Heat/Cold 40.00%
- Moving Mechanical Parts 60.00%
- Needles/Sharp Objects 40.00%
- Potential Electric Shock 40.00%
- Potential for Physical Assault 40.00%
Organizational Profile:
Since its inception in 1953, Memorial Healthcare System has been a leader in providing high-quality healthcare services to South Florida residents. Today, it is one of the largest public healthcare systems in the nation with over 13,000 team members and highly regarded for its exceptional patient- and family-centered care. Memorial's patient, physician and employee satisfaction rates are some of the most admired in the country, and the system is recognized as a national leader in quality healthcare.
Memorial has a reputation as one of Florida's leading healthcare systems and is supported by a distinguished medical staff. In fact, the vast majority of physicians are board certified or board qualified in their specialties and have been trained at many of the nation's finest medical schools and hospitals. Because of its distinguished medical staff and services, Memorial draws patients from South Florida and beyond.
Many prestigious healthcare awards have been earned by Memorial Healthcare System and its facilities. The accolades include: Modern Healthcare magazine's Best Places to Work in Healthcare, Florida Trend magazine's Best Companies to Work for in Florida, 100 Top Hospitals, Consumer Choice Award, Best-Run Hospital, Best Nursing Staff, Best Pediatric Hospital and Best Maternity Hospital.
Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.
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Salary.com Estimation for Auditor - Compliance - MPG: CORP - Compliance & Int Audit in Hollywood, FL
$50,134 to $65,454
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